Latest Advances regarding on Surgery.
American scientists from the Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA have recently shown the trends in the use of images to advance women undergoing surgery for breast cancer. Evidence-based guidelines recommend perioperative diagnostic imaging limited to newly diagnosed breast cancer. For patients with age> 65 years, using conventional imaging (mammography, ultrasound and x-rays) remained stable, while the advanced imaging (computed tomography [CT] scans resonance nuclear medicine [ emission tomography / s], and magnetic scans [RM] use) has increased. In this study, the authors evaluated the use of traditional and advanced image among younger patients (age </ = 65 years) who underwent surgery for breast cancer. The MarketScan commercial claims database research finds 2005 to 2008 were analyzed to evaluate the use of conventional and advanced diagnostic imaging associated with surgery for ductal carcinoma in situ (DCIS) or stage I to III invasive breast cancer. The cohort study included 52,202 women (13% with ductal carcinoma in situ, and 87% of breast cancer in phase IIII). The proportion of patients who undergo conventional imaging techniques remained stable, while the average conventional imaging tests per patient rose from 4.21 in 2005 to 4.79 tests per patient testing 2008 (p <0.0001). For advanced images, the proportion of women who underwent images increased 48.8% in 2005 to 68.8% in 2008 (p <0.001) and the number of tests per patient (from 1.53 tests tests in 2005 to 1.98 in 2008, P <0.0001). MRI scans accounted for nearly all the increase in advanced imaging. Patients who underwent MRI examinations received much more traditional imaging tests compared with those who did not, indicating that these tests are additive and not replace traditional image. The present results demonstrate that use of peri-operative breast MRI has increased among women aged <65 years. The study further indicated to determine whether the benefits of this procedure justify greater use.
American scientists and physicians from the Department of Bioengineering, University of California San Diego, 9500 Gilman Drive MC: 0412, La Jolla have recently shown the in vivo efficacy of allografts osteocondrals fresh frozen goat before 6 months associated with PRG4 secretion. The long-term efficacy of allografts osteocondrals is due to the presence of viable chondrocytes in the cartilage graft. Chondrocyte allografts in osteocondrals, especially the articular surface that normally produce lubricating proteoglycan4 (PRG4), are susceptible to death storageassociated. The hypothesis of this study is that the loss of chondrocytes within osteocondrals grafts leads to a decrease in the secretion of PRG4, after storage and subsequent implantation of the graft. The objectives were to determine the effect of treatment with allograft osteocondral (vs FROZEN FRESH) on the secretion of PRG4 functional after (i) storage, and (ii) 6 months in vivo in adult goats. Frozen storage reduces allograft cartilage PRG4 secretion by approximately 85% compared to the fresh allograft storage. After 6 months in vivo function for allografts PRG4secreting osteocondrals dropped frozen prior to storage by approximately 81% compared to fresh allografts by about 84% versus non-operated control cartilage. Also, the cellularity in articular surface in frozen allografts was approximately 96% lower than fresh allografts and operated cartilage. Thus, the function of allografts seems PRG4secreting maintained in vivo based on their state after storage. PRG4 secretion may be a useful marker not only the profitability of the allograft, but also a biological process that protects the articular surface grafts after repair of cartilage.
Chinese scientists from the Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China have recently shown the effect of penehyclidine hydrochloride on the incidence of intraoperative awakening in Chinese patients undergoing breast cancer surgery during general anesthesia. Intraoperative awakening can lead to serious adverse psychological consequences. They performed a prospective, randomized doubleblinded in 920 patients undergoing surgery for breast cancer biespectral indexguided intravenous anesthesia to evaluate the effect of intraoperative awakening penehyclidine hydrochloride. The patients were divided at random to receive 0.01 mg.kg (1) penehyclidine hydrochloride or saline intravenously 30 minutes before surgery. The preadministración, levels of preoperative anxiety was assessed using a visual analogue scale of 100 mm. Awakening was defined as intraoperative memory of intraoperative events using a modified Brice interview administered 26 hours after the operation, and the next 2448 h. A committee of three experts, blind to the conditions of the study were analyzed independently reported all the memories. No differences were found in the depth of anesthesia and preoperative anxiety levels of patients between the two groups. The incidence of awareness penehyclidine hydrochloride (patients 0/456, 0%) was significantly lower than with saline (5/452, 1.1%), p = 0.030. They conclude that penehyclidine hydrochloride reduced the incidence of intraoperative awakening in patients undergoing breast cancer surgery during general anesthesia.
Chinese scientists and physicians from the Department of Surgery, Shanghai Public Health Center Affiliated Clinical Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China have recently shown the preoperative risk factors that influence the incidence of postoperative sepsis in patients infected with human immunodeficiency virus. Compared with patients infected with human immunodeficiency virus (HIV) infected patients undergoing surgery have a higher risk of developing postoperative sepsis. The aim was to investigate preoperative risk factors that affect the incidence of sepsis after surgery in patients infected with HIV. The clinical data of 215 patients with HIV / acquired immunodeficiency syndrome (AIDS) who had undergone surgery between January 2011 and February 2012 retrospectively examined the impact of HIV / AIDS, the incidence of postoperative sepsis. Logistic regression analysis identified four independent risk factors of postoperative sepsis in patients infected with HIV: CD4 [B = 0.007, odds ratio (OR) 993], the levels of albumin in the blood ( B = 0.077, OR 0926), surgical infection (B = 1.887 or 6.598), surgery (B = 1.013, OR 2754). The incidence of postoperative sepsis was highest with CD4 <100 cells / = / multilateral levels, albumin <35 g / L, the presence of surgical infection, the patient had undergone major surgery81.25% 39 / 48, 76.47%, 26/34, 70.73%, 29/41, and 54.76%, 46/84, respectively, compared to the total cohort (40.93%, 88/215) . When CD4 counts were> 350 cells / Mul, the incidence of postoperative sepsis was significantly lower (16.36%, 9/55). Low counts of CD4 cells, hypoalbuminemia, surgery and surgical infection are independent risk factors for the development of postoperative sepsis in patients infected with HIV. Number of CD4 cells and albumin levels negatively correlated with the incidence of postoperative sepsis, whereas surgical infections and major surgical procedures positively correlated with the incidence of postoperative sepsis.
Swedish scientists from the Upper Gastrointestinal Research Unit, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden have recently shown that the influence of surgical factors persistent symptoms 3 years after surgery of esophageal cancer. A population-based study in Sweden. Little is known about the long-term effects of surgical approach and type of anastomosis in the surgical treatment of esophageal cancer in the results patientreported. A Swedish study nationwide, population-based cohort included patients undergoing esophagectomy for esophageal cancer in 20012005. The exhibits included pre-surgical approach (transthoracic or Transhiatal) and the technique of the anastomosis (sutured manually or mechanically). The results were esophagealspecific symptoms 3 years after surgery. Symptoms were measured using the questionnaire of quality of life cancerspecific the QLQC30, supplemented by module cancerspecific esophagus (QLQOES18), both developed by the European Organization for Research and Treatment of Cancer. Logistic regression models were used to estimate relative risks, expressed as odds ratios (OR) with 95% confidence intervals (CI) experience symptoms as assessed from questionnaires. Of 178 patients included, there was a turnout of 84%. There were no statistically significant differences regarding surgical approach. However, the point estimates indicate that patients operated with a focus Transhiatal had a lower risk for symptoms of nausea and vomiting (OR = 0.5, 95% CI 0.11.9), diarrhea (OR = 0.5 95% CI: 0.21.8) and difficulty swallowing (OR = 0.4, 95% CI: 03), and a slightly greater risk of loss of appetite (OR = 2, 95% CI 0.75.6) compared with patients operated with transthoracic approach. Anastomotic technique does not change the risk for any of the selected symptoms. The surgical approach and type of anastomosis did not seem to influence the risk of cancer and general symptoms esophagealspecific 3 years after surgery for esophageal cancer.
South korean scientists and physicians from the Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary Hospital, Faculty of Medicine, Catholic University of Korea, Seoul, Korea have recently shown the role of preoperative colonoscopy in patients with gastric cancer. A case-control study of the prevalence of colorectal neoplasia coexistence. They evaluated the prevalence of coexistence of asymptomatic colorectal neoplasia (CRN) in patients with gastric cancer (GC). Preoperative colonoscopy examinations were performed in 495 patients with gastric cancer underwent gastrectomy between January 2009 and December 2010. Compare the prevalence of CRN to these patients as well as in a normal population, they selected 495 people agematched sex and underwent colonoscopy for the detection of health. Risk factors for CRN were evaluated by univariate and multivariate analysis. The overall incidence of CRN was 41.8% (414/990). The prevalence of CRN, CRN high risk, and colorectal carcinoma (CRC) were significantly higher in GC than in the control group (CRN global: 48.9% versus 34.7%, high risk CRN: 28, 3% to 13.5%; CRC: 2.6% versus 0.2%, all P <0.001). The presence of GC [odds ratio (OR) 1.82, 95% confidence interval (CI), 1:42:38, p <0.001], age> / = 50 years (OR 2.58, 95% CI, 1.753.81 P <0.001) and male sex (OR 2.28, 95% CI 1.723.02, p <0.001) were risk factors for all CCC. In patients with GC, aged> / = 40 years (OR = 3.22, 95% CI 1.248.37, p = 0.016) and male sex (OR 3.21, 95% CI 2.174.76, p <0.001) were risk factors for general CRN. The prevalence of coexistence of CRN, including CRC was higher in patients with GC than in the normal population. Preoperative colonoscopy is strongly indicated in patients with GC who are men and / or> / = 40 years of age.
American scientists from the Center for Surgery and Public Health, Department of Surgery, Brigham & Women Hospital, Boston, MA, USA have recently shown the variation in the use of reconstruction after mastectomy in elderly women. Regardless of age, women who choose to undergo reconstruction report after mastectomy improves quality of life as a result. However, the effective use of reconstruction decreases with age. While this may reflect the preference of the patient and clinical factors, may also represent agebased disparity. Women aged 65 years or older who underwent mastectomy for ductal carcinoma in situ / stage I / II breast cancer (20002005) were identified in the database SEERMedicare. The overall rates and institutional reconstruction was calculated. Characteristics of hospitals with higher and lower rates of reconstruction were compared. PseudoR (2) statistics using a logistic regression model patientlevel estimated the relative contribution of the actors of the institution and the patient. A total of 19,234 patients in 716 institutions were examined. Overall, 6% of elderly patients received reconstruction after mastectomy. Institutional rates ranged from zero to> 40%. Considering that 53% of institutions made any reconstruction in elderly patients, 5.6% reconstructions performed in 20%. Although the characteristics of the patient (% delta (2) = 70%), particularly age (% delta (2) = 34%) were the main determinants of rebuilding institutional characteristics also partly explains variation (% delta (2) = 16%). This suggests that, in addition to the appropriate factors, including the clinical characteristics and preferences of the patient, the use of reconstruction among older women is also influenced by the institution where they receive care. The increase in the probability of reconstruction and institution suggests association with structural inequality of access to this critical component of care for breast cancer. Greater awareness of potential age difference is an important first step to improve the access of older women who are candidates for reconstruction and desire.
Indian scientists from the Institute of minimum access, Metabolic and Bariatric Surgery, Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India have recently shown the effectiveness of Block UltrasoundGuided transverse abdominal plane after laparoscopic bariatric surgery. A double-blind, randomized and controlled. The effectiveness of ultrasoundguided transverse plane of the abdomen (USGTAP) blog as part of multimodal analgesia was assessed in morbidly obese patients undergoing laparoscopic bariatric surgery. They studied 100 patients with BMI> 35 kg / m (2). They were randomly assigned to study (USGTAP) and control groups. Pain scores at rest and in motion several time points up to 24 postoperative hours were compared. Other parameters evaluated were patients who require Tramazac hydrochloride (TMZ) as rescue medication, sedation scores, time to walk, adverse events and patient satisfaction. The mean visual analog pain scale score of the study (USGTAP) group was consistently less than 1, 3, 6, 12, and 24 hours at rest and in motion, in the postoperative period. Number of patients requiring TMZ requires in the first third and sixth hour was significantly lower in the group USGTAP. The sedative effect of the prolonged TMZ affected when walking. Patients in the control group remained more sedated. Four patients in the control group required BIPAP support after the operation, there was no adverse effect. Walking time was 6.3 + / 08/01 has USGTAP and 8 + / 1/8 h control group, p <0.001. Patient satisfaction scores were significantly higher in USGTAP, p <0.001. Their study demonstrates that USGTAP as part of multimodal analgesia technique in morbidly obese patients undergoing laparoscopic gastric bypass reduces the need for opioids, improved pain score, sedation decreases favors early ambulation, and has increased patient satisfaction.
Singaporean scientists and physicians from the Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, 5 Second Hospital Avenue, Singapore 168938, Singapore have recently shown the effect of radiotherapy on mandibular reconstruction using a modular endoprosthesis. The stent system has proven to be a potential option mandibular reconstruction. The aim of this pilot study was to test animals in vivo effects of postoperative radiation using brachytherapy on bone and soft tissue healing in mandibles reconstructed with endoprosthesis. Six adult Macaca fascicularis jaws were reconstructed with cemented prostheses after segmental resection of the body. The animals were divided into two groups. The test group was subjected to radiation therapy 1 month after surgery, whereas the control group did not receive any radiation. The results showed no major side effects of radiation. Ulceration of the mucosa and wound dehiscence broadcast sites healed in 4 weeks. One animal in each group had prosthetic failure and was unable to complete the study. MicroCT findings indicated that there was no significant difference between the percentage of total bone volume (TBV%) of the study and control groups. Histomorfomètric analysis using rating scales did not show significant differences between the two groups. Under the conditions of this study, postoperative brachytherapy did not affect the response of the tissue around the stent within the time period 6 months after radiation. The stent thus remains a viable reconstructive when postoperative radiation is prescribed.